International Journal of Ageing and Later Life, 2009 4(1): 23 – 54. # The Authors
Successful aging as an oxymoron: older
people with and without home-help care talk about what aging well means to them
By SANDRA TORRES1 & GUNHILD HAMMARSTRÖM2
Abstract
Notions of what it means to age well or successfully are central to social
gerontological research and practice. As such, one would expect that there
would be consensus as to what the construct of successful aging means
and/or how aging well is achieved. This is not, however, the case which is
why this study explores the meanings that a group of older people (i.e.
some with home-help care and some without) attach to this construct. The
empirical material is constituted of 16 semi-structured interviews. The
findings bring to fore the different resources (such as physical, mental,
psycho-social, spiritual, and financial ones) that are associated with
successful aging and the kind of outlook on life that is regarded as useful
if one wants to age well. Differences between home-help care recipients
and those that do not receive this type of care were found. Those that are
managing without the help offered by home-help care services listed more
resources and offered more nuanced descriptions of what successful aging
1
Sandra Torres, National Institute for the Study of Ageing and Later Life (NISAL), Campus
Norrköping, Linköping University, Norrköping, Sweden.
2
Gunhild Hammarström, Department of Sociology, Uppsala University, Uppsala, Sweden.
23
International Journal of Ageing and Later Life
means than those that receive home-help care. This suggests that receiving
home-help care and/or not being able to manage primarily on one’s
own might shape the manner in which older people think about what
constitutes a good old age. The in-depth analysis of the notions of
successful aging that were brought to the fore suggests also the
paradoxical fact that the title of this article attests to; namely that some
associate aging well with not aging at all and deem, in fact, the term
successful aging to be an oxymoron.
Keywords: successful aging, aging well, older people, aging, home-help
care recipients.
Introduction
Ideas regarding what it means to age well and/or successfully date back
to Cicero’s writing from 44 BC (Bowling 1993; Rodeheaver 1993). They
permeate most social gerontological research and practice still, even
though there is no consensus as to how the construct of successful aging
should be defined, how it can be operationalized and how it is best
measured. The fact that we are yet to reach an agreement in these respects
is rather puzzling, especially if one takes into account that this construct
has been a highly debated one since its inception into the vernacular of
aging research some 50 or so years ago. Stock (1982) has suggested that it
was the establishment of the Committee on Social Adjustment to Old Age
by the American Social Science Research Council that gave this construct
the place it undoubtedly has in social gerontology. Fisher (1995) has
argued, however, that it was not until the Gerontological Society of
America made successful aging the theme of their 1986 annual meeting
that this construct became established so to speak as one of
gerontology’s guiding principles. He argues also that Rowe and Khan’s
now seminal article on successful aging (published originally in 1987)
played also an important role in establishing this term since this was the
first piece of work that explicitly challenged the idea that aging and
disease came hand in hand.1
There has been some debate as to when the idea of successful aging was
first documented, when the term was originally launched within social
24
Successful aging as an oxymoron
gerontology and when it was in fact established as one of our discipline’s
guiding principles. Successful aging is, therefore, still regarded as a highly
controversial and much debated concept (e.g. Thomas & Chambers 1989).
It has, for example, been argued that the successful aging paradigm that
Rowe and Khan launched is parochial since it fails to take into account the
fact that age-related losses and dependency can be defined differently and
that there are numerous ways to age well (Scheidt et al. 1999). Some have
also contended that this paradigm is a blatant example of the fact that
it is the Western template that dominates the gerontological imagination
(Thomas & Chambers 1989); a fact that is problematic in a highly
globalized world since non-Western understandings of this construct
are seldom taken into consideration (Torres 2001, 2003, 2004). Dannefer
(1987) has also argued that the focus on normative outcomes that is often
characteristic of gerontological work on successful aging fails to acknowledge the fact that old age is a social construction. Strawbridge et al.
(2002) have, in turn, pointed out that the word ‘‘successful’’ suggests a
competition, which some gerontologists find problematic; an angle that
has been debated by disability researchers as well who have argued that
the paradigm does not take into account the realities of those who age
with disabilities (Minkler & Fadem 2002).
The suitability and applicability of this construct has been debated on
numerous occasions. The popularity of successful aging has not, however,
been dissipated by the controversy. Giving older people in different
circumstances a voice in the matter seems therefore like a fruitful way to
go about contributing to the never-ending debate about this construct.
They are, after all, ‘‘the most appropriate people to define successful
aging/ . . ./ and although some researchers have made a start in this area,
far more work needs to be carried out’’ (Bowling 1993: 452); an assessment
that still stands even though more than a decade has passed since it was
demonstrated that older people themselves are seldom given a chance to
say what successful aging means to them. Thus, in this article we explore
the understandings of successful aging that are upheld by a group of older
people in two different predicaments; half of them receive help and
support in their everyday lives from home-help care services, while the
other half does not. The reason why we will focus on these groups is not
only that the literature on older people people’s own understandings of
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International Journal of Ageing and Later Life
successful aging is relatively scarce, but also that very little research on the
importance of present life situation for these understandings has in fact
been conducted.
Literature Review
Successful aging studies have progressed over the years by moving their
focus from the state or ‘‘what’’ of successful aging to the strategies through
which we age well, i.e. the ‘‘how’’ of successful aging (e.g. Baltes &
Carstensen 1996; Torres 2001, 2004). A look at the body of evidence
collected through social gerontological endeavors that have looked into
successful aging specifically2 suggests also that there are at least three
types of approaches to research in this area. The first one can be traced to
Rowe and Khan’s (1987, 1997, 1998) attempt to define successful aging by
proposing what the state of successful aging entails. They define successful
aging as low probability of disease and disability, high cognitive and
physical-functional capacity and active engagement with life; a definition
which has been criticized for several reasons, including its lack of cultural
sensitivity (Scheidt et al. 1999; Torres 1999, 2001); its poor acknowledgement of the fact that aging implies not only losses but gains (Baltes &
Carstensen 1996); its inability to encompass the realities of disabled older
people (Minkler & Fadem 2002), and the inherent class bias that
characterizes this approach (Cole 1984). Nevertheless, successful aging
research, which aims to identify the conditions necessary to age well and
which focuses on the objective measurement of successful aging, has
grown over the past few years and further measures of this state, such as
sustained personal autonomy (Ford et al. 2000) and well-being (Westerhof
et al. 2001), have been proposed. Thus, although this is a highly debated
construct, it has been acknowledged that Rowe and Khan’s definition (as
problematic as it might be) did in fact have a positive effect on the study of
aging and old age, since it argued that aging and disease were two
different things and it encouraged a shift in focus from people doing
poorly to people doing well (Strawbridge et al. 2002). This is probably why
studies of successful aging have continued to be designed and why other
ways of approaching the study of this construct continue to be delineated.
There are also studies that have worked on how successful aging is
achieved by focusing on the strategies people use to age well (e.g. Baltes &
26
Successful aging as an oxymoron
Baltes 1990) as opposed to trying to define what the state of successful
aging entails. As such, these studies represent attempts to overcome
some of the problems associated with the normative focus on outcomes
described earlier. Proponents of this approach believe that it is problematic
to define successful aging as objective outcomes which only a few older
people can achieve, which is why they argue that a shift in focus is
necessary if we are to allow the heterogeneity of older people and of sociocultural and historical constructions of success to be addressed (Baltes &
Carstensen 1996). Thus, their focus is not on what constitutes successful
aging per se but on how older people go about achieving a successful old
age despite the various increasing limitations in resources that growing old
can entail. This type of research focuses on the process of successful aging
as opposed to the state of aging successfully and has often concentrated on
the testing of the theoretical model that Paul and the late Margaret Baltes
first formulated the SOC model. Researchers working from this
perspective tend to focus on how the strategies of selective optimization
with compensation, which have been launched as the key to aging well,
actually work, and on identifying the various outcomes that are associated
with them (such as well-being, positive emotions, and absence of feelings
of loneliness; e.g. Freund & Baltes 1998).
The third and last research type that can be identified with regard to
successful aging is the one that is of particular relevance to the task at
hand. This last type aims to shed light on the understandings of successful
aging that older people uphold. Proponents of this approach argue for
the theoretical fruitfulness embedded in older people’s perspectives, since
these are believed to be necessary for gerontological practice, patientcentered care and clinical programs (Phelan et al. 2004). Some of the
studies belonging to this category have been designed in such a way that
the older people interviewed have been asked to rate statements according
to how important they believe them to be to aging well, while others have
asked participants to define what the construct means to them without
offering any preconceptions of how it can be defined. Regardless of which
study design is employed, these types of studies aim to give the older
population a voice in order to see if and how their perspectives differ from
what we already know in terms of successful aging as a state and as a
process.
27
International Journal of Ageing and Later Life
In their study of college students’ and independent living adults’
opinions of successful aging, Charbonneau-Lyons et al. (2002) used a
rating method and found that social and familial relationships, intrinsic
values, financial concerns, accomplishments, cognitive functioning, physical appearance, and independence are believed to be factors that
contribute to successful aging. Torres (2001, 2003, 2009) used vignette
methodology to clarify the relationship between cultural values and
understandings of successful aging, and found that there are a variety of
ways in which this construct can be understood. Her findings show that
not everybody associates aging well with the mastering of nature and with
the future and productivity orientation that is so common in established
definitions of successful aging within mainstream gerontology. The study
of von Faber et al. (2001) compared results regarding objective measurements of successful aging with what older people believed to be necessary
in order to age well and found that older people’s views on the subject
were more process-oriented than state-oriented. They tended also to value
well-being and social functioning higher than physical and psychocognitive functioning. Thus, because character and attitude were found
to be so central to the manner in which the older people interviewed
viewed successful aging, these researchers concluded that ‘‘the absence of
limitations and losses does not constitute one’s success at old age; rather,
success is measured by the way these limitations and losses are integrated
into one’s attitude to old age’’ (von Faber et al. 2001: 2699).
The idea that attitude is central to older people’s understandings of
successful aging has been confirmed by the various studies that have been
launched to explore, with a more traditional qualitative approach, the
meaning attached to this construct. Fisher (1992, 1995), who was among
the first to explore the meaning older people themselves attach to this
construct, set out to clarify this and another construct that is often used by
aging researchers; i.e. life satisfaction. He found that people’s understandings of successful aging involve attitudinal or coping strategies nearly
twice as often as their understandings of life satisfaction, and that
successful aging ideas were often described in present and future-oriented
terms, whereas understandings of life satisfaction tended to be more
oriented toward the past (Fisher 1995). The features associated with
successful aging were, in short, interactions with others, a sense of
28
Successful aging as an oxymoron
purpose, self-acceptance, personal growth, and autonomy, which is why
he concluded that the understandings in question suggest an orientation
to life that is future-oriented and adaptive in nature. Dorfman and
Walsh (1996), who collected their data through focus groups, found that
mental aptitude, attitude, social support, and self-care were central to their
interviewees’ understandings of successful aging, while other aspects such
as physical activity, interpersonal behavioral skills, financial status,
autonomy, coping strategies, and a sense of meaning and purpose seem
also to be important even though they were mentioned less frequently.
Fisher and Specht (1999) asked contributors to a senior art exhibition to
define what successful aging meant to them and found, in turn, that aging
well was associated with having a sense of purpose, interactions with
others, personal growth, self-acceptance, autonomy, and health. Collings
(2001) interviewed members of a Canadian Inuit community and found
that they valued an individual’s ability to handle declining health and their
overall attitude toward life (and their willingness to transmit their wisdom
to younger generations) as much more important than good health per se.
Duay and Bryan (2006), who are amongst the latest researchers to explore
the meaning that older people themselves attach to this construct, have
found that senior adults’ understandings of successful aging involve
engaging with others, coping with changes and maintaining physical,
mental, and financial health.
Studies such as these ones have started to yield results that point out
the spheres of life that older people themselves deem to be important in
order to age well. These include coping-related strategies and/or interaction with others whereas other areas such as financial status do not
seem to have been brought up as often. Research in this area is, however,
relatively limited especially if one takes into account that we have yet to
shed light on how different circumstances such as diminished everyday
competence and/or having home-help care affect the manner in which
the construct of successful aging is understood. It is, in other words, too
early to say whether or not studies of older people’s understandings of this
construct challenge the disciplinary understandings of it that have guided
gerontological research over the past few decades. However, one thing that
is already clear is that the few studies conducted have yielded a series of
answers to the question of what successful aging means to those that are
29
International Journal of Ageing and Later Life
undergoing the various types of transitions (such as those implied by
declining health, diminishing everyday competence, and increasing
dependency) that are associated with the process of growing into old
age. This is why we will hereby focus not only on studying the content of
older people’s understandings of successful aging, but also on showing
what characterizes the way in which they formulate their vision of what it
means to age well.
Methodology
The Overall Project to Which this Particular Study Belongs
The research that will be presented departs from data collected for a
project that investigated how ‘‘cognitively healthy’’ older people with
minor physical health problems handle the transition that being in need of
help and support in order to manage everyday life entails.3 The data that
was collected for this project was collected in a two-stage manner.4 The
first wave of data collection was conducted after the second author had
completed a survey on home-help care commissioned by the municipality
of Uppsala, Sweden,5 and realized that qualitative data was needed in
order to shed further light on the situation of older people who are in need
of help and support because of diminished everyday competence. The
second data collection wave was launched after preliminary analysis of the
data collected in the first wave had been conducted, since it was then that
the authors realized that more interviews were needed in order to tap into
the understandings of older people who are managing primarily on their
own despite having health problems and/or having had their everyday
competence diminished by them.
Sampling Strategies and Sample
As is customary in projects that have been designed in a two-stage manner,
a variety of sampling strategies were used to recruit the informants. Some
of them were, as implied already, recruited via a questionnaire used in a
project that the second author of this article conducted about home-help
care while those that did not have home-help care were recruited through
a contact that worked at the local Red Cross as well as through the
30
Successful aging as an oxymoron
snowball technique. The sampling strategies utilized in this project can
therefore be described as a combination of criteria (since age, living on
their own, and being home-help care recipients were among the criteria
used in the first wave of data collection), disconfirming cases (since we did
not want to be limited to home-help care recipients exclusively), and
snowball (e.g. Creswell 1998).
The data that will be utilized in this article consists of 16 interviews
with people between the ages of 77 and 86 who live either alone or with a
spouse (seven men and nine women). All of them are people interviewed
during the second wave of data collection described earlier which is when
questions regarding successful aging were posed. Half of them receive
some home-help care whereas the other half do not.
The Interviews
The interviews lasted between an hour and a half and two hours, and
were all tape-recorded and transcribed verbatim for the purpose of data
storage and analysis. They tapped into a variety of themes, but were semistructured since we were interested in exploring people’s understandings
and needed to follow their own trains of thought and pace. All of the
interviews conducted during the second wave of data collection began
with Activities of Daily Living (ADL) and Instrumental Activities of Daily
Living (IADL) questions since we wanted to make sure that our
informants were, among others, people that could be claimed to have
diminished everyday competence. Table 1 shows a summary of the
responses given by the informants with regards to the questions having to
do with mobility in the shortened ADL and IADL questionnaire that we
used.6 A closer look at the two groups in which we have grouped our
informants and at the number of answers that indicate that they could not
execute and/or needed help with (see the second column of this table)
clearly shows that those that received home-help care listed a fewer
number of activities they could execute on their own (23 compared to the
64 that the non-home help care recipients listed). Hence we tentatively
and cautiously draw the conclusion that the home-help care recipients
interviewed in this study gave answers to the ADL and IADL questions
we posed which indicate that they had more diminished everyday
competence than those who did not receive help from home-help care
31
International Journal of Ageing and Later Life
Table 1. Summary of answers to ADL and IADL questions having to do
with mobility per informant
Informant’s
pseudonyms, age
and group
Number of
answers indicating
Number of answers that they cannot
execute and/or that
indicating that
they receive help
they can execute
with the activities
the activities in
in question
question
Home-help care recipients
Bo (86)
Sören (85)
Niklas (85)
Britta (77)
Hedvig (82)
Annika (84)
Hermine (79)
Eyvind (83)
Number of
questions that
were either not
answered or
which were not
applicable
7
4
4
5
3
4
8
5
4
6
10
11
11
1
3
3
3
2
1
1
Non-home-help care recipients
Hans (79)
6
Alexandra (83)
5
Fredrika (86)
6
Fanny (79)
9
Frans (80)
9
Fredrik (82)
11
Olivia (80)
10
Wilma (86)
8
6
1
2
2
1
2
6
1
5
1
1
1
1
2
services. Of interest is, perhaps, that although Swedish home-help care
services are a general right, they are in fact only awarded on the basis of
an individual assessment of needs which is based, in part, on ADL and
IADL questions. We would also like to draw attention to the fact that the
differences we will be pointing toward cannot be attributed to age since
there were not any major differences in the age distribution of those
belonging to the group hereby referred to as home-help care recipients
and the group that was managing without the help of home-help care
services. This comes across if one pays attention to the ages of the
32
Successful aging as an oxymoron
informants which are disclosed in parentheses next to their pseudonyms
in both tables.
The particular section of the interview guide that is at stake in this article
is the one that tapped into successful aging. In that section we asked
people to share their thoughts on what aging well means and what they
think is needed in order to age successfully. To this respect it must be
mentioned that the construct of successful aging does not translate well
into Swedish, which is why Swedish gerontologists talk about the ‘‘goda
åldrandet’’ which translates into good aging or aging well when they
are talking about this construct (e.g. Tornstam 2005). This is interesting
in and by itself since it speaks to the kind of translation problems that
highly culture-specific concepts such as success pose (cf. Pahl 1995). The
construct’s culture-specificity notwithstanding, it must be mentioned that
we do not believe that the usage of the Swedish term for this construct
poses a problem since the interviews tapped into the understandings that
our informants had about what aging well meant and what was necessary
in order to have a good old age. Something else worth mentioning when it
comes to the interviews is that what we asked was for people to share their
understandings of successful aging with us and not to assess whether or
not they were aging successfully themselves. Our interest did not, after
all, entail the ‘‘actual’’ state of affairs as perceived by our informants but
how they define different aging-related constructs and whether or not
their understandings in these respects had changed as a result of their
present situation i.e. because they are experiencing diminished everyday
competence, live with various limitations and (in some cases) receive help
and support from home-help care services.
The Analysis
The first phase of analysis for this particular study entailed the identification of themes brought up when our informants shared their understandings of successful aging with us. This means that each of the answers
we obtained regarding successful aging was dissected into the smallest
unit of meaning possible. A total of 36 units of meaning were uncovered in
this stage of the analysis. These units were sorted into categories by virtue
of what they shared in common. Once this sorting out had been
completed, we identified the three types of themes into which the units
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International Journal of Ageing and Later Life
of meaning identified could be categorized. As Table 2 shows, these were:
resource-related statements (five different kinds were identified), attituderelated statements and continuity-related statements. Once these themes
had been uncovered, we proceeded to read and re-read each of the
statements in order to reduce the data so that the meaningfulness of each
of these was emphasized. During this phase of the analysis we realized
that we were in fact dealing with two types of categories: one concerning
what successful aging means [i.e. the different kinds of resources that
seemed to be associated with successful aging be they of a physical,
psycho-social, mental, spiritual or financial nature or the kind of outlook
in life believed to be conducive to aging well] and another concerning how
the understandings of successful aging that were disclosed were in fact
constructed. We have therefore chosen to present our findings in three
separate sections; one concerning the state and/or resources that our
informants associated with successful aging, another concerning the
outlook they described as conducive to a good old age, and a third one
concerning how the understandings in question were formulated.
The Findings’ Credibility: Ensuring the Quality of Qualitative
Research
In order to guarantee the credibility of the findings we shared the
responsibility for data analysis between ourselves. The first author was
responsible for the identification of units of meaning and for sorting these
out into themes and categories, whereas the second author assumed the
role of inter-rater of the analysis in a peer-debriefing session (Cresswell
1998). This entailed the double checking of the units of meaning that had
been identified by the first author and the themes and categories into
which these had been sorted. This involved also suggesting alternative
coding (cf. Silverman 2001). As inter-rater, the second author corroborated
most of the identified units of meaning and the classification of these into
themes, but it was her inter-rater coding that suggested that another
resource type be added (the mental one). Thus, although a relatively high
degree of inter-reliability agreement was reached rather easily, the
credibility of the findings was guaranteed by the alternative coding that
the second author conducted. The peer-debriefing session in question
34
Successful aging as an oxymoron
worked, therefore, for the inter-subjective verification purpose for which it
was conducted (cf. Seale 1999).
Findings
Three different kinds of themes were disclosed with regard to the way
in which the construct of successful aging was understood. These had to
do with resources, attitude, and continuity. The first two themes concerned
the aspects our informants believed to be needed for a person to age
successfully, while the latter was more about the manner in which the
units of meaning were formulated; i.e. the fact that continuity seemed to
have played such a central role when some of our informants described
what successful aging meant for them. It is these findings that suggest that
the term successful aging is perceived to be, as the title of this article
indicates, an oxymoron, since it is not uncommon for people to equate
successful aging with not aging at all. The following section will tap into
this angle after the first two aspects of understanding successful aging (i.e.
resources and attitude needed to age well) are presented.
Resource-related Statements Regarding What Successful Aging
Means
The most common statements made about what successful aging means
entailed the listing of the kind of states and/or resources one needs in
order to age well. Whereas these were of the physical, psycho-social,
mental, spiritual, and/or financial type, our informants often began their
descriptions of what successful aging meant to them by mentioning what
they felt were necessary pre-requisites for aging well. Table 2 shows,
however, that interesting differences were found between the types of
resources that were listed by those with home-help care and those that
manage without. Thus, although informants belonging to both groups
made allusions to physical resources, it was mostly those that did not
receive home-help care that brought up mental, psycho-social, and
financial resources as necessary for a successful old age. This means that
home-help care recipients were in fact less nuanced in their understanding
of successful aging since their answers focused mostly on one aspect;
physical resources being the ones most often brought to the fore in their
35
International Journal of Ageing and Later Life
case. This is, in and by itself, an interesting observation and one that
deserves further exploration since it suggests that present situation might
play a role when understanding of successful aging are being described;
which in this case is related to receiving home-help care and to what seems
to be at least comparatively speaking a higher degree of diminished
everyday competence as suggested by the answers to ADL and IADL
questions shown in Table 1.
With regards to physical resources or health which was the term that
most of them used it must be mentioned that these were listed by the
vast majority of our informants. Aging well seems to be associated with
healthy aging which makes us wonder whether our least healthy
informants would define themselves as successful agers had we asked
them to assess if they were aging well or not. The following informant,
who had rather a hard time formulating what successful aging meant to
him, said for example:
Interviewer: If I were to say to you aging well what would you associate with that
term? What do you consider a successful old age?
Niklas: Hmm . . . whoever came up with that term should explain it to me, I think . . . I
don’t know what it means, I guess, it means different things to different people,
doesn’t it?
Interviewer: I am sure it does . . . but what do you think? How would you define a
good old age?
Niklas: I would . . . if anything . . . I would want to be healthy so that I can move
about. I am disabled. (Niklas, 85 years old, home-help care recipient)
This quote, which is interesting in and by itself because of the hesitation the
informant expressed when first asked to define what successful aging
means to him (a matter which we will discuss in the section on continuity),
shows how being healthy (which in this case seems to be synonymous with
being mobile) often became the first spontaneous thing our informants
brought up when talking about what aging well means. Having said this, it
must be pointed out that although the later part of this quote suggests that
this particular informant did not think that the term successful aging was
useful to describe his situation, we cannot in fact draw that conclusion since
36
Physical
resources
Non-home-help care recipients
Hans (79)
Alexandra (83)
X
Fredrika (86)
Fanny (79)
X
Frans (80)
X
Fredrik (82)
X
Olivia (80)
X
Wilma (86)
X
Home-help care recipients
Bo (86)
X
Sören (85)
Niklas (85)
X
Britta (77)
X
Hedvig (82)
X
Annika (84)
Hermine (79)
X
Eyvind (83)
Informants’
pseudonyms
and age
X
X
X
X
Attitude/
Outlook
X
X
X
X
X
X
X
Financial
resources
X
X
Spiritual
resources
X
X
X
X
X
X
X
X
X
X
X
Psycho-social
resources
X
Mental
resources
Table 2. Understandings of successful aging: distribution of themes by informants
X
X
X
X
X
X
X
X
X
X
X
Continuity
in life
Successful aging as an oxymoron
37
International Journal of Ageing and Later Life
we did not explicitly asked people to assess whether or not they were aging
successfully. The only thing we can say and which we would like to use this
one statement to point out is that being healthy (and in this case, ‘‘being
able to move about’’) was one of the first resources our informants listed
when asked to define what this term means to them. Statements to this end
were made in various ways. Some said, for example:
/ . . . / to be able to still have the opportunity to move about. (Bo, 86 years old, homehelp care recipient)
yeah . . . well . . . it is about being able to remain healthy, not having any aches and
pains. (Hedvig, 82 years old, home-help care recipient)
/ . . . / remaining healthy, I think . . . that is it. (Hermine, 79 years old, home-help care
recipient)
Remaining healthy, having one’s health, being free from aches and pains,
and having physical strength or health were all among the resources that
were spontaneously listed when our informants were asked to define what
successful aging meant to them.
Some of our informants made statements that were more about mental
resources as well. These were people that felt that remaining alert and/or
being able to remember things were needed in order to age well. One of
our informants began to formulate what he felt was needed to age well by
saying:
That demands a bit of thought . . . well, good aging? . . . that is, in my case, about
having some clear headedness left so that one doesn’t need to think about it. (Bo, 86
years old, home-help care recipient)
Clear-headedness, being able to remember things and being alert were all
among the things that were described as pre-requisites, so to speak, to
aging well. When talking about the opposite of a good old age, one of our
informants said, for example, that ‘‘becoming demented’’ (Alexandra, 83
years old, without home-help care) would be the worst. The thought of
losing one’s memory and/or of being afflicted by dementia were often
brought up when our informants tried to describe what the opposite of a
38
Successful aging as an oxymoron
successful old age would look like. Some of those who talked in detail
about their fear of losing their memory talked about this as a threat to one’s
quality of life; a threat some of them thought was more devastating than the
capacity to function physically. It is therefore as if mental resources were
the most coveted even though physical resources (such as good health and
the ability to move around) were also listed spontaneously when our
informants first started to formulate what aging well meant for them.
Psycho-social pre-requisites were also mentioned when trying to
formulate what successful aging meant. Having good relationships with
other people (which some described as being the kind of relationships
which one considers close, and others as relationships which are free
from conflict and animosity), remaining active in one’s social network of
affiliation and maintaining one’s engagement in social events were among
the psycho-social-like resources listed when our informants tried to
formulate their understandings of this construct. Some brought up the
fact that having something meaningful to do was important if one is to age
well, as is being able to enjoy the company of one’s partner in life (which
was an issue brought up by the two informants that still lived with their
partners), one’s children and grandchildren and/or of one’s friends. Thus,
when asked to describe the opposite of successful aging some of them
talked about loneliness and social isolation as ‘‘threats’’ to aging well since
‘‘good friends can cheer one up,’’ as one of our informants said.
Although not as common, some of our informants made resourcerelated statements that tapped into the spiritual sphere. The following
response came, for example, from one of our male informants, who had
always been involved in his local church:
Something else that means a lot, since it is a natural part of who I am is the
congregational community, which I think is also a part of what a successful old age is
all about. To have the wisdom necessary to know upon which leg one stands in one’s
spiritual life, that means a lot as well. (Bo, 86 years old, home-help care recipient)
The financial sphere was also brought up in the interviews. One of our
female informants said the following when asked what she thought
successful aging meant:
39
International Journal of Ageing and Later Life
/ . . . / I think I am aging successfully but that is also because I have . . . I can’t say that
my financial situation is fantastic but I manage and I have a nice home and I . . . so in
that sense I think I have a very good old age even though these are material things but
they mean a lot to be able to have a comfortable life and have it nice and good and as
one wants/. . . / I can afford to do the things I am interested in . . . music, for example,
I can go to concerts and I can afford to travel to visit my children and grandchildren.
(Olivia, 80 years old, without home-help care)
There were a variety of pre-requisites (hereby referred to as resources) with
which the construct of successful aging seemed to have been associated. As
Table 2 clearly shows, some interesting differences were observed with
regards to what the informants listed as needed resources in order to age
well since those without home-help care were in fact more nuanced in the
manner in which they talked about successful aging. They were also as
shown in Table 1 those that listed a higher number of ADL and IADLmobility oriented activities that they could manage on their own.
Attitude-related Statements Regarding What Successful Aging
Means
Some of our informants described an attitude to life that they defined as
conducive to aging well. Interestingly enough, however, only those that
were not home-help care recipients made attitude-related statements when
describing what the construct of successful aging meant to them (see the
next last column of Table 2). Among the things that were mentioned with
respect to attitude are: having a positive approach to things, being curious
enough to learn new things and/or keep up with the latest developments
in, for example, technical advances or music, avoiding nagging and/or
dwelling on difficulties and being able to forget other people’s wrongdoings. Descriptions of successful aging that touched upon the topic of
attitudes were about having the kind of positive and optimistic outlook in
life that one assumes joyful people have.
Some explained why they felt this kind of approach was necessary by
saying, for example, that when one has such an outlook one remains
stimulated and positive, which is good if one is to avoid dwelling on the
various infirmities with which the process of growing into old age is
associated, or as the one couple we interviewed said when asked what is
needed in order to age well:
40
Successful aging as an oxymoron
Frans: It is necessary that one doesn’t have big worries. One could say that we each
have our share of those but we try to disregard them . . . and that one can do a few
things now and then that one has the strength to do.
Interviewer: Hmm . . . is health important?
Frans: Yes.
Fanny: Yes, health is important.
Frans: That is what is important.
Interviewer: But at the same time you say that the tumor is something you disregard.
Frans: Well as long as it doesn’t spread.
Interviewer: Hmm . . . ok.
Fanny: Yes but one just has to accept that. One has some ailments when one is running
around and one thinks that everybody else has it OK but then one starts . . . and then
one sees that everybody is feeble in some way or another.
Frans: Yeah.
Fanny: But it is very important, I think . . . And I think that is something I learned
while being sick that year that one has to have a positive outlook and be curious and
continue to live . . .
Frans: Yeah, and avoid nagging . . .
Fanny: Well one has to be able to nag sometimes . . . [we all laugh] . . . but one can’t
dwell on it.
Frans: Yes, that is probably more important.
Fanny: That one continues to be curious and like that . . . (Frans, 80 years old, without
home-help care & Fanny, 79 years old, without home-help care)
Outlook-related statements were, in other words, made in order to allude
to the kind of attitude one needs in order to be able to manage the various
vicissitudes that are associated with the process of growing into old age.
One of our informants said the following when asked to describe what the
opposite of successful aging would be like:
41
International Journal of Ageing and Later Life
Successful aging, ha . . . if I were to remember earlier wrongdoings that would be bad
aging . . . if I were to get hung up on those and try to exploit them in some way . . .
that would be bad aging . . . let me see if I can think of more examples for what bad
aging means/. . . / Bad aging is also when all possible sorts of physical handicaps crop
up . . . well what I just mentioned about remembering wrongdoings . . . that is not
physical but on top of that if one were to have physical handicaps . . . well that would
naturally be bad aging but that can be compensated for by a kind of more forgiving
and understanding attitude to things (Hans, 79 years old, without home-help care).
In this quote we see how different types of themes were intertwined in
this idea that successful aging entails a positive and tolerant outlook on
life. This particular informant pointed also out that even though physical
handicaps could be perceived as a threat to a successful aging, one’s
approach to them is just as important.
Related to the idea that it is up to us to decide how to handle the various
challenges that life and aging pose is also the idea that remaining engaged
and/or remembering that one needs to continue to do what one can to
make sure that one gives of one’s best is also conducive to aging well. One
of the women we interviewed talked, for example, about this when the
topic of social relationships came up, and she spontaneously began by
saying that being surrounded by one’s children and grandchildren was
important, as was having a good social network. But as she reflected more
she said the following:
Yes, a good social network, that is . . . but then it depends also a lot on how one is . . .
There are many that . . . one hears sometimes . . . well it maybe doesn’t matter if I tell
but . . . there is this old lady that sulks and says oh, I am so lonely . . . And yes but one
must also . . . one must give of one’s best so to speak. One can’t just sit in a chair and
wait for others to come . . . and like, one has to do that and if one can’t, for there are
some people that can’t . . . they don’t have the strength to do that and what not, but
one has to do something also . . . and this woman that I am talking about . . . the only
thing she does is nag about everything, everything is wrong. It is never clean in the
laundry room and it is always dirty in the elevator and it is this and it is that and I
think that maybe it isn’t that strange that she is so alone, for who has the strength to
put up with her so I think that one must, one must give everything in a way . . . One
has to try, I think. (Olivia, 80 years old, without home-help care)
Thus, as expressed by this informant and so many of the other ones that
talk about the importance of having a positive outlook in life, successful
42
Successful aging as an oxymoron
aging was believed to be associated with having the kind of attitude that
makes life easier just because one approaches things in an open and
tolerant manner. These were people that believe in the fact that it was in
their power to age well since it was not all a question of how healthy one
was and/or what kind of situation one has but also of how one tackles the
various difficulties with which aging is associated; how one approaches
life. It can therefore be said that this understanding of successful aging
brings to the fore the idea that aging well is, to a certain extent, a question
of mind over matter.
Lastly, when it came to ‘‘the what’’ of successful aging there were those
that thought successful aging was about the various ‘‘gains’’ that the
process of aging brings about. For example, one of the men we interviewed
said the following when asked what came to mind when he heard the
construct in question:
To be able to remember, to be able to do things in a calmer way, whether it is reading,
or writing or taking a walk . . . there is a sort of calmness, a sort of relaxation that I
don’t think one can reach as a younger person and which I don’t think a younger
person would appreciate . . . young people prefer that which is stressful and exciting
and not that which is calm and relaxed. And I have to say that it is fun to be able to
appreciate this calmness. And that is one of the things that one could count amongst
the pros of growing old . . . that one can become more relaxed. (Hans, 79 years old,
without home-help care)
So whereas successful aging was described in terms of an outlook one
has and/or one that is gained as we age, it is clear that some of the older
people interviewed thought of aging well in terms of an attitude and/or
approach to life in general, and aging as a process in particular.
Continuity-related Statements About What Successful Aging
Means: When Aging Well is Understood as Not Aging at all
As mentioned earlier, this particular theme does not have to do with what
informants defined as necessary pre-requisites to aging well. Instead, this
one theme is about how some of our informants formulated their
understandings of successful aging; i.e. the manner in which they talked
about what aging well entails. The in-depth analysis of our informants’
perspectives on aging well showed that understandings of successful
43
International Journal of Ageing and Later Life
aging irrespective of whether or not they were upheld by those that were
managing without home-help care services were often framed in terms
of continuing with business as usual so to speak. The underlying message
being, in a way, that one ages well if one could ‘‘freeze time’’ and remain
the same. Some of our informants seemed, for example, rather tentative
when they were first asked what successful aging meant to them. It was as
if they were hearing an oxymoron that they needed time to reflect on, and
they wanted to have further explained, which is perhaps what one of
the men interviewed Niklas eloquently expressed when he wondered
where the term successful aging came from (as he is cited doing a few
pages ago). Irrespective of how our informants reacted when they first
heard the term, it is clear that most of them could easily formulate their
vision of successful aging as the interview progressed. Few seemed
actually to have a problem describing what aging well meant to them
despite the initial hesitation and/or tentativeness that accompanied most
of their formulations of what aging well means.
In addition to this interesting observation and related to this continuity
theme is the fact that some of our informants formulated their definitions
of successful aging by referring to the way things were at the moment and
the fact that being able to carry on as they were doing was what successful
aging was all about. For example, when talking about the importance of
health for aging well some of our informants made statements such as ‘‘to
be able to remain as healthy as I am today.’’ In this regard it must be added
that when our informants talked about having their health they did not
mean being ‘‘disease free’’ but rather ‘‘not getting worse.’’ In a similar
manner, others began to formulate what successful aging meant to them
by saying, for example: ‘‘Well, above all . . .that I am able to be who I am
today’’ or as one of our informants said:
A good old age is . . . in my case it is about having my senses left / . . . / I think that it is
very important that I can continue to have a fairly normal ability to communicate . . .
(Bo, 86 years old, home-help care recipient)
Thus, the idea that continuity is needed in order to age well permeated the
understandings of successful aging that this study brought to fore. As one
of our informants said, ‘‘if nothing worse happens to me other than what
has happened already (which in this informant’s case meant the two back
44
Successful aging as an oxymoron
operations she had had) then I will be very grateful’’ (Britta, 77 years old,
home-help care recipient). The informants that talked about successful
aging in terms of continuity suggested that the construct in question seems
to have been perceived as a contradiction in terms since aging was about
getting to a point where one was no longer able to continue as usual. This
makes sense if one takes into account that these were people that seemed
to associate the process of growing into old age with ‘‘falling prey’’ to the
various difficulties that aging seems to have been expected to bring about.
For example, after making numerous remarks about having thought about
what the various challenges associated with aging would feel like, one of
our informants said the following:
Well, it is clear that years pass by you know and that one just has to you know realize
that, sooner or later, one will become a victim of old age as one might maybe say [the
interviewer asks him what this means and he responds] well, it can you know . . . it
means some sort of . . . it is probable that one can . . . that troubles will increase in one
way or another . . . Body-wise or spiritual ones or whatever it might be that can crop
up . . . so it is just that . . . I mean that it is because of this that I say this . . . one never
knows you see . . . how it will be so in a way it is just an objective assertion that that is
just life. (Fredrik, 82 years old, without home-help care)
The process of growing into old age seemed to have been implicitly
assumed to be a threat to continuity in life (cf. Torres & Hammarström
2006, 2007) which is why we are suggesting that some of our informants
seemed to draw a parallel between successful aging and not aging at all.
This might explain why some of them went as far as saying in a joke-like
manner that successful aging was about ‘‘being young forever;’’ a
statement that was not really typical of the statements of most of our
informants made but that captured the essence of what all of those that
made statements regarding continuity in life seemed to have wanted to
convey. Continuity in life is, after all, about wanting things to stay the
same and about assuming that the future holds changes that imply
deterioration in one way or another. Our informants’ understandings of
successful aging suggest that the term can be regarded as an oxymoron
since aging is believed to be about the kinds of transitions that jeopardize
being able to continue as usual and to age well one would need to be able
to ‘‘freeze time’’ since remaining the same is the only way in which one
45
International Journal of Ageing and Later Life
could avoid the various deteriorating transitions with which aging seems
to have been associated.
Discussion
The findings hereby presented corroborate previous research on understandings of successful aging since health was found to be central to aging
well (cf. Duay & Bryan 2006; Fisher & Specht 1999). Another aspect of
successful aging, which previous research has brought to the fore and
which our study also shed light on, is the importance of psycho-social
resources, i.e. having good social relationships, remaining active in one’s
social networks of affiliations as well as in social events, and having
something meaningful to do. Thus, whether described as social functioning (cf. von Faber 2001); interpersonal behavioral skills (cf. Dorfman &
Walsh 1996) and/or interactions with others (cf. Fisher 1992, 1995 as well
as Fisher & Specht 1999), our ability to remain active and engaged socially
seems to be among the aspects that people deem to be conducive to
successful aging along with having a sense of purpose and meaningfulness. Spiritual and financial resources were mentioned by some of our
informants even though these were issues that were not brought up as
often. The importance of spirituality has been identified as important by
others (cf. Ruffing-Rahal & Wallace 2000), as has the issue of finances (cf.
Charbonneau-Lyon et al. 2002; Duay & Bryan 2006). Thus, these are also
some aspects that our study has in common with previous research, even
though one could say that these were issues that were relatively peripheral
to most of the understandings of successful aging that our informants
expressed.
With respect to the importance of health and physical resources it must
be mentioned, however, that this aspect was exclusively brought up by
those that indicated in their responses to the ADL and IADL questions
we posed and in comparison with those that were managing without
home-help care services (as shown in Table 1) that there were numerous
activities that they were either not able to execute on their own and/or
needed help with. Here it seems necessary to reiterate that age did not
seem to play a role. The number of activities one had trouble executing on
one’s own or needed help with was not related to the number of years one
46
Successful aging as an oxymoron
was. Something else worth reiterating is that these were people that were
home-help care recipients. Hence that the findings suggest that it might
only be those that are relatively healthy and physically able who define
successful aging in other terms besides those related to physical resources.
The underlying idea being that understandings of successful aging can
only ‘‘afford’’ to be about something else besides health when one is still
relatively healthy. The size of our sample and our study’s design does not
allow us to draw the conclusion that home-help care recipients are more
prone to think of successful aging in more narrow terms than those who
manage without the help of home-help care services because they are still
relatively mobile and are not yet hindered by their diminished everyday
competence. Future research should, however, explore this further since it
might very well be that as people’s own physical resources deteriorate and
their need for help and assistance with everyday activities increases they
begin to think of aging well in health-exclusive terms. Our own research
has shown, for example, that there is a relationship between how people
think about diminished everyday competence and how they conceive the
process of growing into old age (cf. Torres & Hammarström 2006). The
question that the findings presented here pose is therefore whether degree
of diminished everyday competence is related to how we think about
successful aging and what we deemed to be needed to age well.
The importance of attitude toward life in general, and the various
changes that aging brings about in particular, were also amongst the issues
that some of our informants (those that were not home-help care
recipients) associated with aging well. Statements that stressed having a
positive approach, being curious, avoiding nagging and dwelling on
negative issues, forgiving wrongdoing and remaining stimulated were
made by the informants that were managing without the help of homehelp care services and these were classified under the umbrella concept of
attitude-related statements. It must, however, be stressed that what these
statements tap into are, in fact, an issue that has often come up as one of
the key aspects of successful aging (cf. Dorfman & Walsh 1996) even
though some research refers to this in other terms (such as self-acceptance
as in the case of Fisher 1992, 1995 as well as Fisher & Specht 1999 or coping
with change as in the case of Duay & Bryan 2006). Related to this is also
the fact that our findings suggest that we need to look further into whether
47
International Journal of Ageing and Later Life
or not there is a relationship between being in need of help and support
and how one thinks about the attitude-oriented aspect of successful
aging.7
Last but not least, there are the findings that show that some of our
informants thought of aging well in terms of remaining the same and/or
‘‘freezing time;’’ findings that show that these informants think of aging as
deteriorating change which is why they formulated their understandings
of successful aging by suggesting that aging well is about not aging at all.
This is, of course, in line with the provocative statement that Baltes and
Carstensen (1996) once made when they alluded to the fact that ‘‘some
critics argue that successful aging is an oxymoron; successful aging means
not aging at all’’ (Baltes & Carstensen 1996: 400). Our findings suggest that
it might very well be that some older people think of this construct in such
a way. Conceived in this manner, successful aging is about remaining the
same, i.e. about continuity.
Concluding Remarks
The findings having to do with what successful aging is and the aspects
believed to be conducive to aging well are in line with what previous
qualitative research about older people’s understandings of successful
aging has identified. The heterogeneous sampling strategy utilized in
this study allowed us, however, to make an interesting contribution to the
ongoing debate by suggesting that present circumstances such as being a
home-help care recipient and having diminished everyday competence might have an impact on the way in which older people think about
successful aging. The findings having to do with how the understandings
were formulated are also interesting since they suggest that even though
most people can define what this construct means to them, there are some
that formulate their understandings in a manner that suggests that this
very popular gerontological construct is, in fact, an oxymoron to them.
By unveiling the manner in which understandings of successful aging
are formulated we have tapped into how the process of growing into old
age can be viewed. Aging seems to have been regarded as a process
associated with numerous threats to the way things are at present, which
is why some of our informants seemed initially to have a hard time
48
Successful aging as an oxymoron
formulating what aging well entailed. Most of our informants could,
however, define rather easily what successful aging meant to them once
they began to list the pre-requisites or resources they believed to be needed
in order to age well and the type of outlook in life they deemed to be
conducive to successful aging. Future research should explore how the
understandings in question are mediated by the different circumstances in
which older people can find themselves. Our findings suggest (albeit
tentatively), after all, that being a home-help care recipient and degree of
diminished everyday competence might have an impact on how older
people think about successful aging.
Acknowledgements
The research upon which this article is based was funded through grants
from the Swedish Research Council (Vetenskapsrådet) and the Faculty of
Social Sciences at Uppsala University. We would also like to thank the
members of the Social Gerontology Research Group at the Department of
Sociology of Uppsala University for their support throughout this project.
Notes
1. When referring to Rowe and Khans’ contribution, Strawbridge et al.
(2002) have argued that what was innovative about their way of
thinking about aging is that it suggested that one could in fact age
successfully (i.e. disease-free), which was something totally different
from thinking that one could have a good old age despite disease.
2. Hereby we would like to stress what we have already pointed out in the
introduction; namely that the idea of aging well has always been an
underlying theme for research on adjustment, adaptation and coping
(cf. Tornstam 1973) even though the actual term ‘‘successful aging’’ is
relatively new. Our interest in this construct is, however, not historical,
which is why we deem the discussion regarding the origins of
successful aging to be peripheral to our endeavor. Our literature review
focuses, therefore, on literature that uses the term successful aging
explicitly since our interest lies in the differences there might be
between what aging well is believed to be (by the social gerontological
literature) and how elderly people define the term.
49
International Journal of Ageing and Later Life
3. Other results from this project can be found in Hammarström and
Torres (2005, 2007, 2009) as well as in Torres and Hammarström (2005,
2006, 2007).
4. A total of 49 interviews were collected during the course of this project.
Only 37 interviews qualified, however, as useful data since some of the
interview tapes had poor sound quality and some of our informants
were deemed to lack lucidity or failed to answer our questions. This
particular study is, however, based on the 16 interviews in which we
asked about successful aging explicitly.
5. Results of this survey can be found in Hammarström (2001, 2002).
6. The shorter version that we used is composed of 35 items. In this article
we focus only on the twelve items that have to do with mobility.
7. Our own research has shown, for example, that being in need of help
and assistance does not necessarily mean that one regards oneself as
dependent (cf. Hammarström & Torres 2007, 2009), which is why it is
important to keep in mind that parallels cannot automatically be drawn
between circumstances which might at first glance seem similar (such
as being in need of help and assistance and regarding oneself as
dependent and/or for that matter having such assistance and
thinking about successful aging in a given manner).
Corresponding Author
Sandra Torres, National Institute for the Study of Ageing and Later Life
(NISAL), Campus Norrköping, Linköping University, Norrköping 60174,
Sweden. Email: [email protected]
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